medigraphic.com
ISSN 0035-0052 (Print)

2000, Number 2

<< Back Next >>

Rev Mex Pediatr 2000; 67 (2)

Use of high frequency ventilation and surfactant in newborns with aspiration of meconium syndrome and persistent pulmonary hypertension

Rodríguez BI, Castañeda VMA, Pérez MPY, Rodríguez RV, Jiménez GGA, Rodríguez BR

Language: Spanish
References: 17
Page: 55-59
PDF size: 148.46 Kb.


ABSTRACT

Introduction. Persistent pulmonary hypertension (HPP) secondary to aspiration of meconium (SAM) continues to be a cause of mortality and of the diagnosis found in reports on the use of high frequency ventilation, nitric oxide and ECMO. Our objective was to demonstrate the benefit of the use of high frequency and surfactant in newborns with SAM and HPP. Material and methods. Newborns with the following criteria were included in the study: They were born in our institution, were older than 37 weeks of gestation, were diagnosed with SAM and HPP, VAFO and surfactant (VAFO and S). This group was compared to an historical group management with high frequency interrupted flow (VAFFI) and the measurement of gasses ventilation and indexes of oxygenation were compared. Results. There were seven patients in the study group who fulfilled the criteria for inclusion (VAFO and S) and they were compared to the VAFFI control group. We found that the VAFO and S group had higher PaCO2 (p ‹ 0.05) and bicarbonate (p ‹ 0.01) and a lower index of oxygenation (p ‹ 0.001), inspiration pressure peak (p ‹ 0.001) and medial pressure of air pathways (p ‹ 0.01). Although the survival rate was the same (100%) as well as bronchial pulmonary dysplasia (0%) and the number of hours of high frequency ventilation the VAFO an S group had lowest total ventilation time in hours 98 ± 2.3 vs 29 ± 14; (p ‹ 0.01). Conclusions. The use of high frequency ventilation is effective in the management of HPP secondary to SAM and this study demonstrated that the use of high frequency oscillatory and surfactant is more effective.


REFERENCES

  1. Fanaroff AA, Martin RJ. Neonatal-perinatal medicine: disease of the fetus and infant. 5a ed. St Louis; Mosby year Book Inc 1992: 834-838.

  2. Rodríguez-Balderrama I, Villegas-Álvares C, Castellanos-Morfín JL y col. Comparación de la ventilación de alta frecuencia de flujo interrumpido versus ventilación de alta frecuencia de presión positiva en recién nacidos con diagnóstico de hipertensión pulmonar persistente.

  3. Polin RA, Fox WW. Fetal and neonatal physiology. Philadephia: WB Saunders Company 1992: 1026-1028.

  4. Abu-Osba YK. Treatment of the persistent pulmonary hypertension of the newborn: update. Arch Dis Child 1991; 66: 74-77.

  5. Rodríguez-Balderrama I, Borjas-Omonte I, Rodríguez BR y col. Empleo del sulfato de magnesio en la hipertensión pulmonar persistente del recién nacido. Rev Mex Pediatr 1994; 61: 263-266.

  6. Corzo-Pineda JAD, Joachin-Roy H. Sulfato de magnesio como alternativa de manejo de hipertensión pulmonar persistente del recién nacido. Informe de tres casos. Bol Med Hosp Infant Mex 1995; 52: 372-376.

  7. Pérez-Villalobos HM, Rodríguez-Balderrama I, Lozano-González CH. Experiencia clínica con la ventilación de alta frecuencia de flujo interrumpido en un hospital privado. Rev Mex Pediatr 1997; 64: 247-253.

  8. Goldsmith JP, Karotkin EH. Assisted ventilation of the neonate 3a. ed Philadelphia: WB Saunders Company 1996: 199-214,

  9. Boynton WA, Carlo WA. Pulmonary gas exchange during high frequency ventilation. In: Boynton BR, Carlo WA, Jobe AH, editors. New therapies for neonatal respiratory failure: a physiological approach. New York: Cambridge University Press 1994: 202-217.

  10. Chang HK. Mechanism of gas transport during ventilation by high frequency oscilattion. J Appl Physiol 1984; 56: 553-563.

  11. Bae CW, Takahashi A, Chida S, Sasaki M. Morphology and function of pulmonary surfactant inhibited by meconium. Pediatr Res 1998; 44: 187-191.

  12. Sun B, Herting E, Curstedt T, Robertson B. Exogenous surfactant improves lung compliance and oxygenation in adult rats with meconium aspiration. J Appl Physiol 1994: 1961-1971.

  13. Sun B, Curstedt T, Robertson B. Exogenous surfactant improves ventilation efficiency and alveolar expansion in rats with meconium aspiration. Am J Respir Crit Care Med 1996; 154: 764-770.

  14. Auten RL, Notter RH, Kending JW, Davis JM, Shapiro DL. Surfactant treatment of full-newborn with respiratory failure. Pediatrics 1991; 87: 101-107.

  15. Halliday HL, Speer CP, Robertson B. Treatment of severe meconium aspiration syndrome with porcine surfactant. Colaborative surfactant study group. Eur J Pediatr 1996; 155: 1047-1051.

  16. Findlay RD, Taeusch HW, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics 1996; 97: 48-52.

  17. Daniel WW. Bioestadística: base para el análisis de las ciencias de la salud. México: Limusa, SA de CV 1995: 345-451.




2020     |     www.medigraphic.com